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With help from Joanne Kenen, David Nather, Jennifer Haberkorn, Brett Norman and Natalie Villacorta

SEBELIUS ON CNN: DELAYING OBAMACARE ‘NOT REALLY AN OPTION’ — HHS Secretary Kathleen Sebelius said building Obamacare’s enrollment system could’ve taken five years but that the administration — and the people depending on it for health care — couldn’t afford a longer wait. “There are people in this country who have waited decades for affordable health coverage, people who are so eager for this to happen,” Sebelius told CNN’s Sanjay Gupta on Tuesday night. “Waiting is not really an option.” She also said the president became aware of the HealthCare.gov tech problems shortly after the launch. http://politi.co/HgzDAi

OBAMACARE TECH WOES COULD STRAND HIGH-RISK POOL PATIENTS — Tens of thousands of America’s sickest patients could be tossed from health coverage on Jan. 1 if the problems plaguing the Obamacare enrollment system aren’t solved first, state officials warned Tuesday. About 105,000 patients with medical conditions are insured in 35 state-run high-risk pools that are slated to phase out on at the end of the year. And when they do, those patients will need another option. http://politico.pro/1eHGXko

HEALTH LAW HEARINGS CONTINUE TO PILE UP — This time, CMS Administrator Marilyn Tavenner will be in the hot seat. She’s slated to testify before the House Ways and Means Committee on Oct. 29, a day before Sebelius is expected to testify at a House Energy and Commerce hearing.

— AND HOUSE REPUBLICANS WANTS MORE ACCESS – GOP leadership is requesting a briefing with Obama administration officials about the implementation of the health care reform law after hearing that House Democrats will get a briefing on the law. The Dems will be briefed today by Mike Hash, the head of the HHS Office of Health Reform, at 8:50 a.m.

— INSURERS GETTING ACCESS TOO – The White House is meeting with CEOs of health plans on Wednesday, according to two insurance industry sources. The insurance executives are meeting with Obama adviser Valerie Jarrett and Chief of Staff Denis McDonough, the sources told POLITICO Tuesday evening.

Welcome to Wednesday PULSE, where we’d like to go ahead and formally request a briefing with the president’s inner circle on the Obamacare rollout. We figure after Democrats, Republicans and insurers, the Pro Health Care team can’t be too far down the list.

“Out here in the fields, I fight for my PULSE.”

RYAN: SEBELIUS ISN’T RESPONSIVE – House Budget Committee Chairman Paul Ryan (R-Wis.) says HHS Secretary Kathleen Sebelius has stonewalled his committee and the public on Obamacare. Ryan says the secretary has refused repeated requests for information on implementation of the health law and invitations to testify in front of his committee. “Your continued silence on these important inquiries after refusing to testify raises serious questions about the administration’s commitment to transparency and accountability,” Ryan wrote in a Tuesday letter to Sebelius that was obtained by POLITICO ahead of scheduled release on Wednesday. Ryan plans to release letters dating back to Aug. 15 that he says show a pattern of refusal to testify in front of the House Budget Committee. http://politico.pro/17HCZDb

— HHS RESPONDS: “Secretary Sebelius and other senior HHS officials will begin testifying before multiple committees next week, as they have numerous times in the past," HHS spokeswoman Joanne Peters told POLITICO. “The House Budget Committee requested that she testify in September, on a date when she was unavailable at the time of the request. We are working to be responsive to follow up questions this Committee has sent.” Sebelius has gone before the House Energy and Commerce, Ways and Means, and Education and Workforce committees as well as the Senate Finance Committee this year.

OBAMA MAKES POLITICAL PITCH ON OBAMACARE — President Barack Obama is asking his political allies to send him a health care lifeline. In a YouTube video disseminated by Organizing for Action, the president urged supporters to be part of “Team Obamacare.” “By now you’ve probably heard that the website has not worked as smoothly as it was supposed to,” Obama says in the video. “But we’ve got people working overtime in a tech surge to boost capacity and address the problem, and we’re going to get it fixed.” http://politi.co/19sLs0e

HILL STAFFERS A BOON FOR DC EXCHANGE — Washington D.C.’s new health insurance exchange could be in for a massive influx of Capitol Hill staffers — and that could mean big savings for the nascent system. About 15,000 Hill aides and members of Congress will be eligible to enroll in the D.C. exchange, and the ones who do will almost certainly be disproportionately young and healthy. Pro’s Paige Winfield Cunningham reports: “They’ll provide a steady stream of customers for the D.C. exchange, which faces unusual challenges. At just over 600,000 people, the District is smaller than most states. That makes it harder to gather a pool of healthy people to balance out the costs of sicker enrollees and bring down premiums.” http://politico.pro/179Fu4R

SHAHEEN CALLS FOR ENROLLMENT EXTENSION — A Senate Democrat is calling for a lengthier Obamacare open enrollment period to make up for the time lost to technical malfunctions. Pro’s Jennifer Haberkorn reports that Sen. Jeanne Shaheen has made the request and also asked the White House to clarify whether those who encounter tech problems will be subject to the individual mandate penalty. http://politico.pro/1dguZjZ

TOP REPUBLICAN NOT IMPRESSED WITH ZIENTS – Rep. Tim Murphy, the chairman of the House Energy and Commerce oversight subcommittee, wasn’t too impressed with the administration’s announcement that former OMB acting director Jeffrey Zients will be part of the “tech surge” to fix Healthcare.gov. “I’m disappointed that they put someone in charge of this who’s not a tech person,” Murphy told POLITICO. “If the problem is the software, why do we have someone in charge who doesn’t do this for a living?” Murphy offered the analogy of where someone would take a broken car to be fixed: “You take it to a mechanic. You don’t just take it to Uncle Charlie … I’m sure he’s a nice man, but he’s the wrong person.”

** A message from AHCA. As Congress mulls options to pay for the doc fix this year, skilled nursing and assisted living providers have smart policy alternatives that lower Medicare costs without cuts. We are AHCA. And we are the solution. Learn more at http://ahcancal.org/solutions. **

RUBIO, DEMS SPAR OVER IRS WARNING — Sen. Marco Rubio’s admonition for HealthCare.gov users to document their experience or risk pursuit by the IRS rankled Democrats who yesterday accused the Florida Republican of “fear-mongering.” “The only way Obamacare doesn’t work is if people don’t’ participate in the program,” said Democratic National Committee spokesman Michael Czin. “The statement is fear-mongering and trying to confuse people.” Rubio issued the statement Monday, and he included a warning. “Make no mistake: The IRS will go after anyone who fails to meet the Obamacare requirements, so it's important that consumers document the online problems.” It came on the same day he filed legislation to delay the penalty for lacking health insurance. Rubio’s statement: http://1.usa.gov/19WQwXA

— Asked about the DNC criticism, a Rubio spokesman responded: “We have no reason to believe that the same IRS that singled out conservative groups for audits will now turn a blind eye towards individuals who are unable to fulfill Obamacare's mandates … [C]onsumers who have been unable to purchase Obamacare insurance should take common sense steps to protect themselves from the IRS.”

CAP STUDY: OBAMACARE DEFICIT REDUCTION ON THE RISE — The Center for American Progress, an ardent supporter of the Affordable Care Act, is out with a new study this morning suggesting lower-than-expected insurance premiums available through the law sharply increase the law’s deficit reduction estimates. “These savings will boost the health law’s amount of deficit reduction by 174 percent and represent about 40 percent of the health care savings proposed by … the Simpson-Bowles commission,” according to the report authored by CAP health policy chief Topher Spiro and MIT economics professor Jonathan Gruber. “Moreover, we estimate that lower premiums will lower the number of uninsured even further, by an additional 700,000 people, even as the number of individuals who receive tax credits will decline because insurance is more affordable.” The report: http://bit.ly/1i8soX0

COALITION PUSHING FOR MORE MEDICARE DATA – A coalition of 22 employers, industry and consumer groups urged Congress yesterday to expand access to Medicare claims and quality data to help Americans better shop for providers. The coalition includes the National Association of Manufacturers, Boeing, AARP, the National Coalition for Health Care and the Council for Affordable Health Coverage, among others. The letter, sent to the House Ways and Means and Senate Finance Committees, calls for provisions expanding data access to be included in legislation to address the 25 percent cut in provider pay that the sustainable growth rate formula calls for in 2014. The House letter: http://bit.ly/1bU2ip3

LIZZA: WHITE HOUSE MISREPRESENTED MY TWEETS – The New Yorker’s Washington correspondent Ryan Lizza has a bone to pick with the White House press team. ProPublica’s Charles Ornstein reports that Lizza became a mini-hero to the White House after tweeting last week that he had created an Obamacare account on HealthCare.gov “with no trouble.” But 40 minutes later, when trying to submit his application, Lizza encountered a “please wait” message and tweeted: “So, yes, healthcare.gov is still broken.” White House Press Secretary Jay Carney had already retweeted Lizza’s first tweet, but not the second. Lizza called the false impression left by the White Houses “the Twitter equivalent of blurbing a book using the one positive line from a review that actually trashed the book.” http://bit.ly/HcJQ1v

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WHAT WE’RE READING, by Jason Millman

Amid calls for Sebelius to resign, the New York Times writes that she isn’t deeply involved in the development of the federal exchange website. http://nyti.ms/1gDieCh

One co-op has already closed and another nine are in financial trouble, potentially leaving taxpayers on the hook for $1 billion in bad loans, the Washington Post reports. http://wapo.st/161GneV

Health Care for America Now, which helped lead the push to pass the ACA, will close at the end of the year, Forbes reports. http://onforb.es/Hgpnbj

Rep. Chris Van Hollen, the top Democrat on the Budget Committee, said his party won’t accept entitlement cuts without revenue increases, Reuters reports. http://reut.rs/189s6JI

The feds have asked Blue Cross Blue Shield of North Dakota not to release exchange enrollment data, according to a local report. http://bit.ly/1cVhe7u

The L.A. Times looks at how Colorado is using beer kegs, golf and bros to sell health insurance. http://lat.ms/19tsI0x

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